FastTrack

Despite evidence-based guidelines, cholesterol control in high-risk patients remains persistently sub-optimal. Barriers to effective control include an increasing burden of clinical data and limited time during clinic visits.

We conducted a randomized trial of an informatics-based system to lower LDL-cholesterol (LDL) in patients with coronary artery disease (CAD) or risk equivalents and LDL > 100 mg/dL. For each intervention patient, primary care physicians were alerted via a unique e-mail system linked to the electronic medical record that provided all the pertinent information on one screen: current LDL and trend of past results, medications and drug allergies, liver function results, co-morbidities, text of the last note, and decision support to predict LDL lowering by statin dose. This e-mail provided "one-click" on-screen order writing that allowed PCPs to do any one of the following:

generate a new statin prescription and corresponding patient letter,

generate a completed lab requisition form and letter to repeat a fasting lipid panel, or

defer any action

FastTrack screenshot: Click to enlarge

PCPs received no information regarding their control patients. Baseline LDLs were defined as the most recent test prior to the study's launch. Endpoint values were defined as the first LDL recorded 6 weeks after the intervention e-mail.

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